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New challenges in healthcarePart 2 of the ERS report on two days of reflection on chronic disease: Full report of the ERS ministerial conference, 19 October, Brussels – click on names to view presentations The ERS pre-ministerial conference ‘Chronic Respiratory Diseases – Exploring solutions in the EU’, part of a two day reflection on health policy and chronic disease, was launched 19 October with a welcome from ERS President Marc Decramer followed by a brief word from the Belgian EU presidency on its rationale for placing chronic disease on the EU political agenda. Behind the discussions were the new challenges posed to healthcare systems. 
Left to right Marc Decramer, Dominique Hamerlijnck, John Bowis, Andy Bush, Kai-Håkon Carlsen and Klaus Rabe ERS was one of two organisations invited to organise a pre-ministerial event due to their “commitment to raising awareness of chronic disease and empowering the patient”. This commitment was illustrated by the next speaker Ms. Dominique Hamerlijnck (Netherlands) whose presentation ‘Living with chronic respiratory disease – a patient perspective’ spoke of the impact of chronic respiratory disease through the different stages in the patient’s life. Her remarks were echoed by conference Chairman and and a former UK health minister and Member of the European Parliament, John Bowis, who pointed out that “Nobody who hasn’t experienced a disease understands fully what it feels like to have a disease.” He praised the Belgian presidency for its chronic disease initiative, adding that the day’s proceedings would shed new light and lead to action on prevention, innovative care, patient empowerment and good practice. The experts
The first series of presentations analysed respiratory health issues at various points in life, from early childhood to the later years. Andy Bush pointed out that damage to the vulnerable lungs of young children, especially under the age of four will translate in later life to chronic respiratory disease. Smoking, even air pollution, has an impact on the lungs of the unborn child, while excessive weight gain in the early years can also have negative impacts. “If you start out with poor lung function,” he said, “it will never get better”, adding that a bad start is equivalent to heavy smoking in later life. Kai-Håkon Carlsen focused on the benefits of physical activity on the lung function of young people. He pointed to improved life prospects for children with serious conditions such as cystic fibrosis due to improved treatment and physical training Prof. Carlsen cautioned on the negative impact of excessive training emphasising nonetheless that “If you don’t set aside time for physical activity when you are young, you will regret it later in life.”
Klaus Rabe highlighted the upward curve of respiratory disease compared to other diseases, noting that chronic respiratory illness is associated with increased age, irrespective of risk factors.“The price of ageing is to understand that it will increase the incidence of degenerative chronic diseases,” he said. During his presentation on adult respiratory disorders, he urged policy makers to take into account societal developments such as population migrations, which are already having an impact on the incidence of drug resistant tuberculosis. He added that policy needs to focus on reducing inequalities in healthcare in Europe. Marc Decramer turned his attention to the issue of chronic respiratory disease late in life, highlighting, for example, the sharp rise in deaths due to COPD compared to other diseases, and deploring the lack of funding for research. In addition, the incidence of COPD is frequently underestimated because many cases remain undiagnosed. He stressed the need to switch to more innovative models of patient care, for example self-management, tele-monitoring, tele-consulting and rehabilitation, with a focus on integrated care to take account of co-morbidities in chronic disease. The patient perspective
The expert session was immediately followed by two presentations dedicated to the patient perspective. Lina Buzermaniene stressed the potential of a partnership between health professional and ‘educated’ patient to improve disease management, outcomes and reduce costs. Active involvement will move the respiratory disease patient from victim to active campaigner for the freedom to breathe, she said. Marianella Salapatas insisted on the need for a permanent liaison between patient and policy maker because health impacts on all key areas, from the economy to agriculture, from transport to regional development. She also highlighted COPD as a major public health issue and EFA’s June 2010 call for action at the European Parliament to make the disease a political priority. Luke Clancy focused on tobacco not only as the most significant cause of chronic respiratory disease but itself as an addictive condition.: “I’m pretty sick of people saying it’s a habit; it’s a disease!” he exclaimed, adding that it is a disease that is under-researched and undertreated.. From acute to chronic care
Highlighting ‘Innovative models of care delivery', Dr. Philippe Swennen called for a paradigm shift in the organisation of the healthcare system from acute to chronic/long-term care, from fragmented to coordinated and integrated, from episodic to continuous, from hospital- to community-centred, from doctor dependent to team based, from reactive to preventive, from the patient as recipient to patient as partner, from infrequent to facilitated self-care and from the undervalued carer to the carer supported as a healthcare partner. Dr. Swennen’s remarks were well illustrated in the ensuing moving patient testimonial from Franz Josef Huainigg, confined to a wheelchair and breathing permanently through a portable ventilator, yet independent, living with his family and continuing his work. (See “I want just three things: to live; to be at home with my family; to work …”) Two areas of concernThe morning session of the pre-ministerial conference terminated with two breakout sessions on innovative concepts for chronic respiratory disease prevention, the results of which were reported immediately during a session moderated by Frank Apfel, Managing Director, World Health Communication Associates (WHCA). The session ‘The importance of the environment for lung health (indoor and outdoor air)’ stressed the fundamental right to clean air and called for a second Environmental and Health Action Plan in the EU. The group outlined the need for specific policies aimed at improving air quality, for example using taxation to internalise the health costs of transport and related emissions and introducing tougher standards for air quality in workplace and school. The other breakout session, ‘Physical activity, sleep, obesity and nutrition’, recommended investment in promoting healthy lifestyles and nutrition and that such information should be included in the school curriculum. The group members called for monitoring in areas of child and adolescent growth and highlighted the need to do more to raise awareness of sleep disorders. They recognised the problem inherent in perceiving smoking or obesity as lifestyle choices. Exercise should, they said, be viewed at one and the same time as prevention, maintenance and treatment. Panel discussion
The principal message of Dr. Hans Kluge was that, in the present climate of public spending cuts, it was important to safeguard budgets for education and to ensure a minimum package of health services. He noted that the Organisation for Economic Cooperation and Development (OECD) recommends viewing the economic crisis as an opportunity to reform healthcare*.
Dr. Ryś highlighted current EU actions in the field of prevention, notably lowering emissions and tobacco control measures, adding that the draft cross-border healthcare directive is set to make it easier for patients to access medical treatment abroad and is likely to foster cooperation between difference centres, raise quality and reduce healthcare costs. Prof. Mika Mäkelä described how a low-budget project to treat asthma via a network of healthcare centres in small communities throughout Finland has resulted in early intervention on the disease, improved monitoring and a 70% decrease in hospitalisations. “Community disease needs community solutions,” he said.
Ri de Ridder said Europe was looking for scope for innovation and to improve quality and accessibility of care. He said he hoped conference would make clear what added value Europe can bring to healthcare debate and policy. Monika Kosinska called for political will to resolve inequalities of healthcare, adding that providers must devise cost effective approaches notably through sharing best practice; prevention must, however, remain the priority. Ms. Kosisnka welcomed the notion of eHealth but said it should be patient rather than industry driven. Last speaker of the session, Yves Sibille, explained the rationale behind the ERS Respiratory Roadmap, which, he said, would focus on recommendations and actions to improve performance in prevention, clinical care, research and education. In the ensuing debate, panellists noted that healthcare services had done a good job to date but that the paradigm now needs to change. For research, more effort should go into pinpointing what research should be prioritised. There was an emphasis on political will among ministers to ensure implementation of new approaches aimed at delivering effective care. Where care models work, for example asthma care in Finland, panellists recommended they be used as examples of best practice in other countries and for other chronic diseases such as COPD. It was generally agreed that early diagnosis is the key and that the case should be made for general practitioners to implement spirometry in general practice. According to the panel, generic approaches might be considered for respiratory diseases as a means of raising quality and cutting costs. Such approaches might be derived from evidence-based disease specific interventions. Panellists declared themselves grateful to see respiratory health now in its rightful place high on the public health agenda. From now on, they concluded, everything is a gain. Next week: Part 3. ERS recommendations to the Ministerial Conference, ‘Innovative approaches for chronic illness in Public Health and Healthcare systems’, held 20 October in Brussels, together with a full report of the conference. |
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